Raphael Puig

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

Background: The clinical and hemodynamic assessment at the bedside and the use of pulmonary artery catheter for the estimation of hemodynamic data have been used in decompensated heart failure. However, there are no data on the use of continuous noninvasive hemodynamic monitoring. Objective: To compare the data obtained through noninvasive hemodynamic monitoring with invasive ones in patients with decompensated heart failure and refractory to treatment. Methods: The non-invasive hemodynamic measurements were obtained through continuous monitoring of systemic blood pressure by the pulse wave model (Modelflow) and compared with measurements obtained by the passage of a pulmonary artery catheter, simultaneously. Results: A total of 56 measurements were performed in 14 patients studied on different days and time periods. The correlation index between systolic blood pressure measurements was r = 0.26 (95% CI = 0.00 to 0.49, p = 0.0492) and diastolic ones, r = 0.50 (95% CI = 0.27 to 0.67, p <0.0001). The correlation was r = 0.55 (95% CI = 0.34 to 0.71, p <0.0001) for cardiac index and r = 0.32 (95% CI = 0.06 to 0 53, p = 0.0178) for systemic vascular resistance. Conclusion: There was a correlation between the hemodynamic measurements when compared to noninvasive pulmonary artery catheter measurements. The continuous noninvasive hemodynamic monitoring may be useful for hospitalized patients with decompensated heart failure. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Left ventricular papillary fibroelastoma

We evaluated the case of a patient with Papillary Fibroelastoma (PFE) that presented embolization to the upper right limb. The patient was submitted to percutaneous embolectomy, with fragment removal. The diagnosis was confirmed by transthoracic echocardiogram and anatomopathological analysis of the fragment. The patient chose to undergo the conservative clinical treatment and the follow-up has shown good evolution with no disease recurrence to date. We decided to use this rare and interesting case with the objective of reviewing the current literature and discuss the best therapeutic management.Avaliamos o caso de uma paciente portadora de fibroelastoma papilifero (FEP) que apresentou embolizacao para membro superior direito. A paciente foi submetida a embolectomia percutânea, com retirada do fragmento. O diagnostico foi confirmado por ecocardiograma transtoracico e exame anatomopatologico. Optou-se pelo tratamento clinico conservador e acompanhamento da paciente, que mostrou boa evolucao e nao teve recorrencia do quadro ate o momento. Aproveitamos esse raro e interessante caso na intencao de revisar a literatura vigente e discutir a melhor conduta terapeutica.

Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial

OBJECTIVE: We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure. METHODS: We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction <0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov: NCT01857999. RESULTS: We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg.min, indexed systemic vascular resistance 1918.0 dynes.sec/cm5.m2, cardiac index 2.8 L/min.m2, and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, -49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements. CONCLUSION: Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.

Fibroelastoma papilífero do ventrículo esquerdo

We evaluated the case of a patient with Papillary Fibroelastoma (PFE) that presented embolization to the upper right limb. The patient was submitted to percutaneous embolectomy, with fragment removal. The diagnosis was confirmed by transthoracic echocardiogram and anatomopathological analysis of the fragment. The patient chose to undergo the conservative clinical treatment and the follow-up has shown good evolution with no disease recurrence to date. We decided to use this rare and interesting case with the objective of reviewing the current literature and discuss the best therapeutic management.Avaliamos o caso de uma paciente portadora de fibroelastoma papilifero (FEP) que apresentou embolizacao para membro superior direito. A paciente foi submetida a embolectomia percutânea, com retirada do fragmento. O diagnostico foi confirmado por ecocardiograma transtoracico e exame anatomopatologico. Optou-se pelo tratamento clinico conservador e acompanhamento da paciente, que mostrou boa evolucao e nao teve recorrencia do quadro ate o momento. Aproveitamos esse raro e interessante caso na intencao de revisar a literatura vigente e discutir a melhor conduta terapeutica.

Fibroelastoma papilar del ventrículo izquierdo

We evaluated the case of a patient with Papillary Fibroelastoma (PFE) that presented embolization to the upper right limb. The patient was submitted to percutaneous embolectomy, with fragment removal. The diagnosis was confirmed by transthoracic echocardiogram and anatomopathological analysis of the fragment. The patient chose to undergo the conservative clinical treatment and the follow-up has shown good evolution with no disease recurrence to date. We decided to use this rare and interesting case with the objective of reviewing the current literature and discuss the best therapeutic management.Avaliamos o caso de uma paciente portadora de fibroelastoma papilifero (FEP) que apresentou embolizacao para membro superior direito. A paciente foi submetida a embolectomia percutânea, com retirada do fragmento. O diagnostico foi confirmado por ecocardiograma transtoracico e exame anatomopatologico. Optou-se pelo tratamento clinico conservador e acompanhamento da paciente, que mostrou boa evolucao e nao teve recorrencia do quadro ate o momento. Aproveitamos esse raro e interessante caso na intencao de revisar a literatura vigente e discutir a melhor conduta terapeutica.